Table of Contents

December 4, 2007; 147 (11)

Articles

  • Treatment of Hepatitis B e Antigen–Positive Chronic Hepatitis with Telbivudine or Adefovir: A Randomized Trial

    • Henry L.Y. Chan,
    • E. Jenny Heathcote,
    • Patrick Marcellin,
    • Ching-Lung Lai,
    • Mong Cho,
    • Young M. Moon,
    • You-Chen Chao,
    • Robert P. Myers,
    • Gerald Y. Minuk,
    • Lennox Jeffers,
    • William Sievert,
    • Natalie Bzowej,
    • George Harb,
    • Ralf Kaiser,
    • Xin-Jian Qiao,
    • Nathaniel A. Brown,
    • and and the 018 Study Group
    Ann Intern Med December 4, 2007 147:745-754

    The best way to suppress viral replication in chronic hepatitis B remains an open question. In this 52-week open-label trial, 135 adults with hepatitis B e antigen–positive chronic hepatitis were randomly assigned to telbuvidine or adefovir for 52 weeks, or adefovir for 24 weeks followed by telbivudine for 28 weeks. At 52 weeks, the reduction in viral load was similar in the telbivudine-only and adefovir-to- telbivudine groups and greater than that in the adefovir-only group.

  • Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults

    • Daniel S. Budnitz,
    • Nadine Shehab,
    • Scott R. Kegler,
    • and Chesley L. Richards
    Ann Intern Med December 4, 2007 147:755-765

    Data from a national surveillance study of adverse drug events and a national outpatient survey indicate that U.S. adults age 65 years or older have more than 175 000 emergency department visits for adverse drug events yearly. Drugs that should never be prescribed accounted for 3.6% of these visits, whereas 3 commonly indicated drugs—warfarin, insulin, and digoxin—accounted for more than one third of them. Strategies to decrease adverse drug events among older adults should focus on these 3 drugs.

  • The Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulant Therapy for Venous Thromboembolism

    • James D. Douketis,
    • Chu Shu Gu,
    • Sam Schulman,
    • Angelo Ghirarduzzi,
    • Vittorio Pengo,
    • and Paolo Prandoni
    Ann Intern Med December 4, 2007 147:766-774

    The decision to discontinue anticoagulation for venous thromboembolism (VTE) depends in part on the risk for a fatal recurrence after stopping. In cohorts from 2 source studies that monitored 2052 patients for an average of 5 years after discontinuing anticoagulation for a first episode of VTE, the annual risk for any fatal pulmonary embolism was 0.43 event per 100 patient-years, and the risk for definite or probable fatal recurrent VTE was 0.17 event per 100 patient-years. Decision makers must take these rates into account if they decide to stop anticoagulant therapy.

Academia and Clinic

  • Professionalism in Medicine: Results of a National Survey of Physicians

    • Eric G. Campbell,
    • Susan Regan,
    • Russell L. Gruen,
    • Timothy G. Ferris,
    • Sowmya R. Rao,
    • Paul D. Cleary,
    • and David Blumenthal
    Ann Intern Med December 4, 2007 147:795-802

    In a survey of physicians in 6 specialties, most of the 1662 responders agreed with statements in the Charter for Professionalism about principles of fair distribution of finite resources, improving access to care and quality of care, managing conflicts of interest, and professional self-regulation. However, self-reported adherence to the norms of professional behavior falls short of ideal.

Updates

  • Update in Oncology

    • Lowell E. Schnipper
    Ann Intern Med December 4, 2007 147:775-782

    This Update features 10 articles published in 2006. Topics include lung, gastroesophageal, breast, and gynecologic cancer, and leukemia.

Perspectives

  • Ventilator-Associated Pneumonia—The Wrong Quality Measure for Benchmarking

    • Michael Klompas and
    • Richard Platt
    Ann Intern Med December 4, 2007 147:803-805

    Legislators, payers, and quality-of-care advocates are considering whether to require hospitals to report ventilator-associated pneumonia rates as a way to evaluate quality of care. Accurate diagnosis of ventilator-associated pneumonia, however, is notoriously difficult, and the current surveillance definition requires considerable subjective judgment. Ventilator-associated pneumonia should not be a component of compulsory reporting initiatives until we develop and validate objective outcome measures that meaningfully reflect quality of care for ventilated patients.

Position Papers

  • Pay-for-Performance Principles That Promote Patient-Centered Care: An Ethics Manifesto

    • Lois Snyder,
    • Richard L. Neubauer,
    • and for the American College of Physicians Ethics, Professionalism and Human Rights Committee
    Ann Intern Med December 4, 2007 147:792-794

    This position paper of the American College of Physicians focuses on potential pitfalls of pay-for-performance programs. Incentives for good performance on specific elements of a condition may lead physicians to neglectother elements of care for complex patients or to discharge such patients from their practice. “Playing to the measures” is another risk. The primary focus of the quality movement should be on the patient, not on “paying for” or “performance” assessment based on limited measures.

Clinical Guidelines

  • Screening for High Blood Pressure: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement

    • U.S. Preventive Services Task Force
    Ann Intern Med December 4, 2007 147:783-786

    A targeted literature search sought new evidence on the direct benefits and harms of screening, and on the harms of treating screen-detected or mild to moderate hypertension. The U.S. Preventive Services Task Force (USPSTF) found no new substantial evidence that would lead it to change its 2003 recommendation. It therefore reaffirms its recommendation that clinicians screen for high blood pressure in adults age 18 years or older.

  • Evidence for the Reaffirmation of the U.S. Preventive Services Task Force Recommendation on Screening for High Blood Pressure

    • Tracy Wolff and
    • Therese Miller
    Ann Intern Med December 4, 2007 147:787-791

    This evidence update supports the USPSTF recommendation on screening for high blood pressure. The only new evidence was about the harms of treatment of early hypertension: Although pharmacologic therapy is associated with common side effects, serious adverse events are uncommon.

Editorials

  • Evolution of Therapy for Chronic Hepatitis B: Progressing from the Simple to the Complex

    • Jordan J. Feld and
    • Marc G. Ghany
    Ann Intern Med December 4, 2007 147:806-808

    In this issue, Chan and colleagues tested telbivudine alone, adefovir alone, and adefovir followed by telbivudine in 135 hepatitis B e antigen–positive patients. Their 24-week results more accurately reflect an initial treatment response compared with their 52-week results, and rates of sustained response and loss of hepatitis B surface antigen (HBsAg) remain poor. New drugs aimed at novel antiviral targets are needed to achieve HBsAg loss and successfully prevent and manage resistance.

  • Medical Professionalism and the Parable of the Craft Guilds

    • Harold C. Sox
    Ann Intern Med December 4, 2007 147:809-810

    The medieval European craft guilds are the antecedents of today's professions. As a commentary on the article by Campbell and colleagues in this issue, the Editor argues that, like the guilds, the medical profession exists in a 3-way relationship with government and business. The parable of the guilds teaches us that community institutions must adapt or wither.

On Being a Doctor

  • An Uneasy Understanding

    • Adrienne E. Shapiro
    Ann Intern Med December 4, 2007 147:811-812

    One month into medical school, I arrived in the ultrasonography suite to join my preceptor for the afternoon. I fought to hide my dismay that my first patient would be a moving image on a screen. So much for learning about the doctor–patient relationship, I thought.

Letters

  • Risks of Intravenous Immunoglobulin in Sepsis Affect Trial Design

    • Sujoy Khan and
    • W. A.C. Sewell
    Ann Intern Med December 4, 2007 147:813

  • Risks of Intravenous Immunoglobulin in Sepsis Affect Trial Design

    • Alexis F. Turgeon,
    • Dean A. Fergusson,
    • D. William Cameron,
    • Paul C. Hébert,
    • Lauralyn McIntyre,
    • and Alan A. Tinmouth
    Ann Intern Med December 4, 2007 147:813-814

  • The Declining Number and Variety of Procedures Done by General Internists

    • Jeanne M. Farnan and
    • Vineet M. Arora
    Ann Intern Med December 4, 2007 147:814

  • The Declining Number and Variety of Procedures Done by General Internists

    • Join Y. Luh and
    • Bernard M. Karnath
    Ann Intern Med December 4, 2007 147:814-815

  • The Declining Number and Variety of Procedures Done by General Internists

    • Michael A. LaCombe
    Ann Intern Med December 4, 2007 147:815

  • The Declining Number and Variety of Procedures Done by General Internists

    • Thomas S. Metkus
    Ann Intern Med December 4, 2007 147:815

  • The Declining Number and Variety of Procedures Done by General Internists

    • Robert S. Wigton and
    • Patrick Alguire
    Ann Intern Med December 4, 2007 147:815-816

  • Strategies for Timely and Effective Hospice Discussions: End-Stage Renal Disease

    • Michael J. Germain,
    • Lewis M. Cohen,
    • and Alvin H. Moss
    Ann Intern Med December 4, 2007 147:816

  • Strategies for Timely and Effective Hospice Discussions: End-Stage Renal Disease

    • David J. Casarett and
    • Timothy E. Quill
    Ann Intern Med December 4, 2007 147:817

  • Pharmacogenetics of Efavirenz: Adherence and Virologic Outcomes

    • David J. Cennimo
    Ann Intern Med December 4, 2007 147:817

  • Pharmacogenetics of Efavirenz: Adherence and Virologic Outcomes

    • Jean B. Nachega and
    • Gary Maartens
    Ann Intern Med December 4, 2007 147:817-818

  • Correction: Update in General Internal Medicine

    Ann Intern Med December 4, 2007 147:818

Medical Writings: Book Notes

  • The Bioterrorism Sourcebook

    • Peter Katona
    Ann Intern Med December 4, 2007 147:819

  • Crystal-Induced Arthropathies: Gout, Pseudogout and Apatite-Associated Syndromes

    • Lin A. Brown
    Ann Intern Med December 4, 2007 147:819

Ad Libitum

Medical Notices

  • Medical Notices

    Ann Intern Med December 4, 2007 147:0

Summaries for Patients

  • Antiviral Therapy for Chronic Hepatitis B

    Ann Intern Med December 4, 2007 147:I-16

  • Emergency Department Visits for Adverse Drug Events in Older Adults

    Ann Intern Med December 4, 2007 147:I-24

  • Risk for Fatal Pulmonary Embolism after Discontinuing Anticoagulation

    Ann Intern Med December 4, 2007 147:I-38

  • Screening for High Blood Pressure: U.S. Preventive Services Task Force Recommendation

    Ann Intern Med December 4, 2007 147:I-43

In the Clinic

  • Heart Failure

    Ann Intern Med December 4, 2007 147:ITC12-1

    This issue provides a clinical overview of heart failure, focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits.

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This Issue

December 4, 2007; 147 (11)
  1. Articles
  2. Academia and Clinic
  3. Updates
  4. Perspectives
  5. Position Papers
  6. Clinical Guidelines
  7. Editorials
  8. On Being a Doctor
  9. Letters
  10. Medical Writings: Book Notes
  11. Ad Libitum
  12. Medical Notices
  13. Summaries for Patients
  14. In the Clinic

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